Fresh leaves and stems of P amarus obtained from Delta State Uni

Fresh leaves and stems of P. amarus obtained from Delta State University environment and identified by the plant Curator (Mr Sunday Nimehe and Victor Speaman) in the Department of Pharmacognosy, Faculty of Pharmacy, University of Benin, Benin city, Nigeria where a voucher specimen was deposited for reference. Ethanol (70%), citric acid, glycerin and 1,1-diphenyl-2-picrylhydrazil, DPPH (Sigma Aldrich, Germany). All other chemicals used were of analytical grade and were used without further purification. 100 g of dried plant material was extracted with 1000 ml aqueous ethanol

using a Soxhlet extractor for 24 h. The supernatant was collected and the solvent evaporated using Rotary Evaporator (CH-9230 Flawil, Switzerland). The extract was stored in a refrigerator in an airtight container for further study and formulation. To prepare ABT-888 liquid oral form of the extract, the following steps were taken: (a) Preparation of simple syrup BP: 667 g of sucrose was dissolved in sufficient distilled water to obtain 1000 ml of concentrated simple syrup.

The solution was filtered and the simple syrup was used as vehicle. The different parameters of the various oral formulations were assessed such as pH, physical appearance (colour, taste and odour), and density. Stability study of the oral liquid syrup was carried out at different temperature (i.e. at 4 °C, 27 °C (room temperature) and 47 °C).7 The free radical scavenging capacity of the extracts was determined using DPPH.8 LEE011 DPPH solution (0.004% w/v) was prepared in ethanol. The different formulations were developed in 10 ml distilled water to a final concentration of 0.1 mg/ml. 4-Aminobutyrate aminotransferase After adding 1 ml of freshly prepared DPPH solution, it was incubated for 20 min at 25 °C, they were read spectrophotometrically at 517 nm wavelength.

Vitamin C (ascorbic acid) was used as a reference standard and developed to the same concentration of 0.1 mg/ml. Control sample was also prepared containing the same volume but without any extract or reference standard. Percentage scavenging activity of DPPH was evaluated using Equation 1. equation1 D%=AC−ATAC×1001where D = scavenging activity of extract, AC = absorbance of control and AT = absorbance of test sample. The formulae for the 6 formulations are presented in Table 1. The taste score of the different formulations are presented in Table 2. The physicochemical properties of the extract and formulations of P. amarus such as colour, odour, taste, viscosity, specific gravity and pH are shown in Fig. 1 and Fig. 2 and Table 3 and Table 4. The extract of P. amarus is brown in colour with a characteristic odour and a bitter taste; these were also partly transferred to the formulations. The development of such herbal formulation will mark an important advancement in developing P. amarus into an acceptable oral liquid phytomedicine.

Les cas de vascularites à ANCA (anticorps anticytoplasme des poly

Les cas de vascularites à ANCA (anticorps anticytoplasme des polynucléaires neutrophiles) sont très rares. Ils s’observent surtout en cas de traitement prolongé par un dérivé du thiouracile. La présence d’ANCA a été constatée chez

un tiers à deux tiers des sujets soumis à un traitement au long cours par le PTU. S’il est important de préciser que la présence d’ANCA n’est pas nécessairement liée à l’apparition de signes cliniques de vascularite, selleck compound leur survenue constitue cependant un facteur de prédiction du risque d’angéite. Dès lors, le recours à une autre thérapeutique doit être envisagé. Les ANCA ont été observés aussi mais plus rarement sous thiamazole, et même chez les basedowiens avant tout traitement. Il n’y a pas d’étude randomisée qui ait définitivement établi la supériorité d’un antithyroïdien en termes d’efficacité, de coût ou de tolérance. Toutefois, il est manifeste que l’activité antithyroïdienne des imidazolines est plus forte. Chez l’enfant, il est déconseillé d’utiliser en première intention les dérivés du thiouracile, du fait de rares cas d’hépatite cytolytique sévère, constatés surtout lors de l’utilisation de PTU

à forte dose. Celles-ci ont conduit à des insuffisances hépatiques définitives, nécessitant une greffe hépatique. Dans les hyperthyroïdies sévères et celles liées aux surcharges iodées (hyperthyroïdies de type 1), l’utilisation préférentielle de PTU a été suggérée selleckchem du fait de sa capacité à réduire essentiellement la désiodation de T4 en Dipeptidyl peptidase T3. Dans ces situations, il faut tenir compte toutefois des altérations

de la désiodation déjà présentes, du fait de la sévérité de l’état général, de l’utilisation éventuelle de la corticothérapie ou du propranolol, ou lorsque l’hyperthyroïdie s’est constituée sous amiodarone ; de plus, la nécessité de fortes doses d’antithyroïdiens légitime aussi l’utilisation possible des présentations disponibles de thiamazole ou de carbimazole. L’utilisation préférentielle du PTU est recommandée lors de l’initiation des grossesses chez les femmes atteintes de maladie de Basedow soumises à un antithyroïdien. En effet, les aplasies du cuir chevelu, les embryopathies des ATS (omphalocèle, atrésies choanales ou œsophagiennes, malformations diaphragmatique, cardiaque…) n’ont été décrites que sous imidazolines, même si elles ont pu survenir en l’absence de traitement, et chez les sujets indemnes de pathologie thyroïdienne. En revanche, leur survenue n’a pratiquement jamais été rapportée sous dérivés du thiouracile, ce qui légitime l’utilisation du Propylex® si l’initiation d’une grossesse sous ATS est programmée, ou possible (en l’absence de contraception efficace).

The dynamics of the lesions’ healing process following laser trea

The dynamics of the lesions’ healing process following laser treatment after week 1 suggest a strong dependency on the loss of initial fluence at each specific laser spot, presumably attributable to small media opacities and overlying retinal edema. The overall persistence of polarization-scrambling columns over the course

of 3 months indicates a much more intense healing reaction and proliferation of RPE cells than previously shown in rodent studies. These findings might support the hypothesis that the beneficial effect of grid and focal photocoagulation is driven by an increase in metabolically active RPE PD98059 manufacturer tissue. This study was limited by its small sample size, its short follow-up period, and the use of only 1 laser system. Nevertheless, the setting is adequate to demonstrate the ability of polarization-sensitive SD-OCT to identify and automatically segment the retinal pigment epithelium in different stages of healing following photocoagulation, in contrast to current SD-OCT devices. Considering further development of minimal-damage photocoagulation, such as subthreshold or selective retinal treatment,28, 30 and 31 polarization-sensitive OCT is a new modality to investigate the therapeutically induced changes of defined retinal Z VAD FMK layers in the human eye over time. All authors have completed and submitted the ICMJE Form for Disclosure Florfenicol of Potential

Conflicts of Interest. M. Pircher, E. Götzinger, and C.K. Hitzenberger have received research

support from Canon, Tokyo, Japan. C.K. Hitzenberger has received lecture fees from National Institute of Health, Bethesda, Maryland. Publication of this article was financially supported by the Austrian Science Fund (FWF grant no. P19624-B02, Vienna, Austria) and the European Union (project FUN OCT, FP7 HEALTH, Contract No. 201880). The high-definition OCT system was provided by Heidelberg Engineering. Polarization-sensitive OCT was constructed and provided by the Center for Biomedical Engineering and Physics, Medical University of Vienna, Vienna, Austria. Contributions of authors: design and conduct of the study (J.L., M.B.); data collection (J.L., M.G.); management (J.L., M.B.); analysis and interpretation of the data (J.L., M.G.); design and construction of polarization-sensitive OCT device (B.B., M.P., E.G., C.H.); and review and approval of the manuscript (M.B., C.H., U.E.). The authors thank Ferdinand Schlanitz and Christopher Schütze for helping with recording the polarization-sensitive OCT images and Robert Blum for English proofreading. All three are members of the Department of Ophthalmology at the Medical University of Vienna, Vienna, Austria. For further information on members and mission statement of the Diabetic Retinopathy Research Group (DRRG), Vienna, please visit: http://www.meduniwien.ac.

An inert atmosphere was maintained by purging nitrogen gas at a f

An inert atmosphere was maintained by purging nitrogen gas at a flow rate of 50 ml/min. The prepared microparticles of all batches were accurately Roxadustat cost weighed. The measured weight of prepared microspheres was divided by total amount of all the excipients and drug used in preparation of the microspheres, which give the total percentage yield of microspheres. The percentage yield was then calculated by using the formula: Percentyield=(Amountofmicrospheresobtained/Theoreticalamount)×100 The theoretical amount is the sum of weight of all the non-volatile solid ingredients used in the process. The flow characteristics of different

microparticles were studied by measuring the angle of repose employing fixed funnel

method. The angle of repose was calculated by using the following formula. Tanθ=h/rwhereθ=tan−1(h/r)Where, h = height of pile, r = radius of the base of the pile, θ = angle of repose. Bulk density and tapped density were measured by using 10 ml of graduated cylinder. The pre weighed sample was placed in a cylinder; its initial volume was recorded (bulk volume) and subjected to tapings for 100 times. Then the final volume (tapped volume) was noted down. Bulk density and tapped density were calculated from the following formula. Bulkdensity=massofmicroparticles/bulkvolume Tappeddensity=massofmicroparticles/tappedvolume www.selleckchem.com/products/abt-199.html Compressibility index (CI) or Carr’s index value of microparticles was computed according to the following equation: Carr’sindex(%)=[(tappeddensity−bulkdensity)/tappeddensity]×100

Hausner ratio of microparticles was determined by comparing the tapped density to the bulk density using the equation: Hausner’s ratio = tapped density/bulk density. For size distribution analysis, 250 mg of the microparticles of different sizes in a batch were separated by sieving, using a range of standard sieves. The amounts retained on different sieves were weighed. The mean particle size of the microparticles was calculated by the formula.10 Meanparticlesize=∑(Meanparticlesizeofthefraction×Weightfraction)∑(Weightfraction) An accurately weighed portion of microparticles equivalent to 5 mg of Glibenclamide were Resminostat weighed and transferred in to a mortar. Powdered and dissolved in 100 ml of pH 7.4 phosphate buffer, suitably diluted and the absorbance of the resulting solution was measured at 228 nm.11 Entrapment efficiency was calculated using the formula.12 Entrapmentefficiency=EstimatedpercentdrugcontentTheoreticalpercentdrugcontent×100 Estimated percent drug content was determined from the analysis of microparticles and the theoretical percent drug content was calculated from the employed core: coat ratio in the formulation of microparticles. Morphology and surface characteristics were studied by Scanning Electron Microscopy. The samples for the SEM analysis were prepared by sprinkling the microparticles on one side of the double adhesive stub.

3–10 1 mg and 1 0–3 1 mg in adults and children, respectively) T

3–10.1 mg and 1.0–3.1 mg in adults and children, respectively). This confirms the assumptions made by the EFSA and the WHO that the established thresholds are regularly exceeded, in particular in children—cf. above. In addition, the CHMP based its assessment of chronic aluminium toxicity on pharmacovigilance databases (reports of serious and non-serious adverse events from the register of spontaneous reports or from clinical studies)

from Germany from 1988 to 2008 (7638 reactions were analysed). Due to the low number of potential aluminium-associated side effects reported (except for the known granulomas), the CHMP arrived at the conclusion that there are no safety concerns. To what extent such a database is suitable to detect associations between SCIT and the development of diseases, which could have a latency period, remains to be seen. In their conclusion, the Safety Working Party to the CHMP places the cumulative aluminium JNJ-26481585 concentration dose of 12 mg aluminium absorbed from a 3-year SCIT (0.5 mg per injection, 6-week interval = 4 mg per year × 3 years of therapy) in the context of an adult’s lifelong cumulative dose of 165–505 mg as “safe oral dietary intake (TWI)”. Thus, the contribution of such an SCIT to the lifelong cumulative total dose is calculated as being fewer than

10%. In connection with the estimation on the basis of the side effects database, the CHMP draws the conclusion that there is no risk from aluminium in SCIT [65]. It is general practice Ku-0059436 solubility dmso in toxicology to consider maximal values (within a licensed indication) of the substance in question. The final assessment of the CHMP does not seem to be based on a similar rationale and it ignored up-titration period(s)

completely. If 1.14 mg (top aluminium-adjuvant dose) is considered and 6-week intervals, then the human body burden of aluminium totals 27.36 mg (1.14 mg × 8 × 3 years). before If the maintenance dose were based on monthly (cf. above) instead of the 6-week intervals, this amounts to 41.04 mg (1.14 mg × 12 × 3 years) and still would not include up-titration. Over the course of their lives, many allergic patients will receive treatments for several allergens—some lifelong (cf. above). The cumulative dose of aluminium from immunotherapy used as basis by the CHMP does not appear to reflect the amount of exposure a patient will receive in practice. In addition to this, it was compared to dietary intake (i.e. the immunotherapy cumulative dose being <10% of this) – a route of administration with a totally different adsorption rate. This is not only misleading but a fundamental mistake. In January 2014 the Paul-Ehrlich-Institut (PEI) published its opinion regarding aluminium in SCIT “Sicherheitsbewertung von Aluminium in Therapieallergenen” [66]. Within this document, the German regulatory authority essentially repeats conclusions drawn from the CHMP in 2010 [65].

In spite of intensive syphilis-targeted public health control ini

In spite of intensive syphilis-targeted public health control initiatives,

including the CDC’s National Plan to Eliminate Syphilis from the US [24] and [25] and the WHO’s Initiative for the Global Elimination of Congenital Syphilis [26], the goal of syphilis elimination has not Selleckchem Talazoparib been achieved. Although the reasons for failure are undoubtedly multifactorial, partial responsibility can be attributed to the complexity of syphilis diagnosis and treatment, and to lack of access or utilization of prenatal screening programs. First, primary syphilis chancres may go undetected if they present in an area that is difficult to visualize (e.g. cervix, throat or anus/rectum) due to their well-documented painless http://www.selleckchem.com/products/INCB18424.html nature [27]. Additionally, syphilis lesions are prone to clinical misdiagnosis, due to their pleomorphic appearance and lack of physician familiarity with the manifestations of syphilis. Secondary syphilis presents as a very mild to severe generalized rash that may go un-noticed by the patient or may mimic a wide range of conditions [28]. Second, the traditional diagnostic screening algorithm comprises a sequence of diagnostic

assays that detect antibodies to lipoidal (e.g. rapid plasma regain [RPR]) and treponemal antigens (e.g. T. pallidum particle agglutination [TPPA]). These assays are generally not available in the clinic and thus their diagnostic success depends on high patient compliance

to return for test results. New point-of-care tests may increase clinic-based serological screening, but their reliance on treponemal antigens makes interpretation of reactive results (which could be due to a prior treated syphilis infection rather than a current active infection) difficult to interpret [29]. Third, the need for parenteral administration of penicillin decreases the likelihood that appropriate treatment will be received nearly in resource-poor settings which contain the majority of syphilis infections. Fourth, antenatal care (ANC) is not always available or sought. Estimates from 2008 show that, of 1.36 million pregnant women presenting with syphilis, 20% had not attended ANC and 66% of infected women who did attend ANC still had adverse outcomes due to lack of either syphilis testing or treatment [30]. Lastly, syphilis control solely by diagnosis and treatment will not decrease the risk of HIV transmission/acquisition. Syphilis treatment-seeking is triggered primarily by signs of early syphilis; such patients may have already missed the window of opportunity for reducing HIV risk, as the ulcerative primary stage of syphilis has the highest risk for HIV acquisition and transmission [31]. Elimination of syphilis infections as a risk factor for HIV will only be fully realized through prevention of syphilis by vaccine development.

From 2002 to 2008, we conducted three trials of NVAS VITA I rand

From 2002 to 2008, we conducted three trials of NVAS. VITA I randomized normal birth weight neonates (≥2500 g) 1:1 to 50,000 IU vitamin A or placebo (2002–2004) [1]. VITA II randomized low birth weight neonates (<2500 g) 1:1 to 25,000 IU vitamin A or placebo (2005–2008) [2]. VITA III randomized normal birth weight neonates 1:1:1 to 50,000 IU vitamin Talazoparib molecular weight A, 25,000 IU vitamin A or placebo (2004–2007)

[3]. The trials are presented in more detail in Table 1. The Early MV trial enrolled 4.5 months old children from August 2003 to April 2007 as described in detail elsewhere [5]. Children were randomized 1:1:1 to three treatment groups: a standard dose of Edmonston-Zagreb (EZ) MV at 4.5 months of age and at 9 months of age (group A); no vaccine at 4.5 months and EZ MV at 9 months of age (group B); no vaccine at 4.5 months and Schwarz MV at 9 months

of age (group C). All children were enrolled and randomized at 4.5 months of age. It was a condition for entering the trial that the children had received the third dose of DTP (DTP3) at least four weeks before enrollment; click here hence, children in groups B and C had DTP3 as their most recent vaccination between 4.5 and 8 months of age. Children in groups B and C who received MV at 9 months of age were randomized to an additional MV or no additional MV at 18 months of age. We found no differences between groups B and C, and hence the two groups have been combined [5]. The also vitamin A trials had mortality by 12 months of age as main outcome; the early MV trial had mortality by 3 years of age as main outcome. In the present reanalysis we studied the effect of NVAS versus placebo between 4.5 and 8 months of age, when the children had early MV or DTP3 as their most recent vaccine, and from 9 to 17 months, when the children according to the protocol had two doses of MV or one dose of MV as their most recent vaccine. Follow-up was censored at age 18 months when children in the one-dose MV group were randomized to a booster

dose of MV or no booster and many children received booster DTP. The trials were registered at clinicaltrials.gov (VITA I: NCT00168597; VITA II and III: NCT00168610; Early MV trial: NCT00168558). All trials were approved by the Research Coordination and Ethical Committee of the Ministry of Health in Guinea-Bissau and the Danish Central Ethical Committee gave its consultative approval. All analyses were done using Stata 12.1 (StataCorp, College Station, TX). Characteristics at enrollment into the early MV trial were compared using chi-square test (categorical variables), t-test (normally distributed continuous variables), and Kruskall–Wallis test (non-normally distributed continuous variables). We compared mortality rates (MR) between NVAS and placebo recipients within strata of early and no early MV in Cox proportional hazards models with age as the underlying time variable. Hence, age was inherently adjusted for.

3B) The median intra-species group

surface-exposed loop

3B). The median intra-species group

surface-exposed loop genetic distances for these Alpha-7 and Alpha-9 L1 sequences were similar at 0.19 (IQR 0.15–0.20) and 0.24 (0.18–0.24), respectively (p = 0.146), and substantially lower than the median inter-species genetic distance of 0.37 (0.35–0.40; p < 0.001). Within the Alpha-9 species group, the antigenic similarity between HPV33 and HPV58 is perhaps reflected in the low genetic distance between these genotypes. The apparent antigenic relationship between HPV39 and HPV59 within the Alpha-7 species group, however, is not similarly reflected by low genetic distances. There AUY-922 concentration were other sporadic instances of weaker cross-neutralization, for example between HPV16, HPV31 and HPV33. Interpretation of these weaker responses, however, has to be tempered by the observation that three of the

thirty-six rabbits generated weak inter-species responses: two animals immunized with HPV31 VLP (one with cross-reactivity against HPV18 and one against HPV68) and one animal immunized with HPV35 VLP (cross-reactivity against HPV45, HPV59 and HPV68). Weak intra-species group responses are intuitively likely to be genuine, but given the inter-species genetic distances in the surface-exposed loops (Fig. 3B) weak inter-species responses should be interpreted Alisertib clinical trial with some caution. Pre-immune sera were negative for neutralizing antibodies against all Alpha-7 and Alpha-9 HPV pseudoviruses and the control BPV (data not shown). A tetravalent preparation containing HPV16, HPV18, HPV39 and HPV58 VLP was used to immunize a group of five NZW rabbits following the same schedule as that for the individual immunizations (Fig. 4). All five Astemizole rabbits generated high titer neutralizing antibodies against the immunizing genotypes HPV16, HPV18, HPV39 and HPV58 and the titers were similar to those obtained when used as individual immunogens with median individual

and tetravalent type-specific neutralization titers for HPV16 (80,813 vs. 161,025), HPV18 (21,941 vs. 17,637), HPV39 (86,678 vs. 53,612) and HPV58 (140,129 vs. 105,258) as indicated (Fig. 2 and Fig. 4). Conversely, the breadth of cross-neutralization seen against the Alpha-7 and particularly the Alpha-9 pseudoviruses was greater than when VLP were used individually: all five rabbits generated neutralizing antibodies against HPV33 and three to four of five rabbits also generated neutralizing antibodies against HPV31, HPV35, HPV45, HPV52, HPV59 and HPV68. None of the five rabbits generated antibodies capable of neutralizing BPV and pre-immune sera were negative for neutralizing antibodies against all Alpha-7 and Alpha-9 HPV pseudoviruses. To establish which of the HPV16 and/or HPV58 VLP immunogen(s) were responsible for the generation of the cross-neutralizing antibody responses against HPV31 and HPV33 we used VLP as competing antigens in neutralization tests (Table 1 and Supplemental Fig.

The ability of bacterially-expressed BTV subunit-vaccines to

The ability of bacterially-expressed BTV subunit-vaccines to mTOR inhibitor induce NAbs and protect

sheep and cattle (natural hosts of BTV) will require further validation. The authors wish to acknowledge funding support from DEFRA, the European Commission (OrbiVac – Grant no.: 245266; WildTech – Grant no.: 222633-2), EMIDA grant OrbiNet – K1303206, BBSRC – Grant number.: BB/D014204/1 and Pfizer. The authors are indebted to Simon Gubbins for advices on statistical analyses. The authors acknowledge ‘Zoetis’ for providing the Zulvac-4®.Conflict of interest: Authors declare no conflict of interest. “
“Using one research methodology is often not enough to tell a full story especially for national vaccine adoption decisions, which often require diverse viewpoints to understand the complete picture. Applying multiple

research methods and triangulating results may capture elements of the story that might be overlooked by one method or the other. In this paper, we apply selleck chemical two research methods in examining decisions to adopt a new vaccine where notable gaps may exist between evidence and policy. These gaps may be particularly important for considerations to add the hepatitis A vaccine into national immunization schedules given the unique characteristics of the epidemiological transition that moves countries from high to low endemicity of hepatitis A. Hepatitis A is an acute liver disease caused by the hepatitis A virus, which is preventable by available safe and highly efficacious vaccines [1]. Since hepatitis A virus is transmitted

through the fecal-oral route, the Edoxaban incidence of hepatitis A vary according to level of socio-economic development. As countries develop and improve sanitation and water supply, childhood exposure to the virus decreases and countries begin an epidemiologic transition, characterized by later age at first infection and increasing incidence of symptomatic hepatitis A. The disease may represent a substantial economic burden in countries transitioning from developing to developed economies with intermediate and high incidence rates, where slow recovery and rare serious complications result in productivity loss, caregiver burden and medical resource utilization. Despite its high efficacy, the hepatitis A vaccine has not been widely adopted into national immunization programs to date [2] and [3]. This study simultaneously carried out a literature review on hepatitis A, supplemented by an internet search and policy interviews about the adoption process for hepatitis A vaccine in six middle- and high-income countries (Chile, India, South Korea, Mexico, Russia, and Taiwan). The literature review focused on capturing epidemiologic, economic or policy articles on hepatitis A in these countries, while key informant interviews set out to understand local stakeholder perceptions about the evidence on hepatitis A infections and its vaccines.

Annually a total of 100 cases were introduced into each one year

Annually a total of 100 cases were introduced into each one year age band between the ages of 5 and 50 years. Children under 5 years old are less likely to be the first individuals infected in an epidemic [26]. Adults over 50 years of age also tend not to be the first infected, due to pre-existing immunity to circulating strains. As a check for coding errors and of the model’s structure and numerical solution, the RAS model was independently recoded as a set of partial differential equations (PDEs) and run using the baseline set of parameter values for influenza A. Firstly, numerical solutions of the RAS model and the PDE model were compared visually. Secondly,

the PDE model population was assumed to Selleck OTX015 mix in a homogeneous fashion and the model was integrated over age to derive an ordinary differential equation (ODE) system in time only. Selleckchem Lapatinib An equilibrium analysis was performed on the ODE system and the numerical solution was compared with that of the PDE system integrated over time. Thirdly, the PDE model was considered at the time-independent equilibrium, resulting in a set of ODEs in age. This system was solved numerically and compared with the equilibrium age profile generated from the

full PDE system. The details of this analysis are included in Appendix B. The simulated age stratified proportion of the population infected was checked for face validity against

corresponding data from the Tecumseh study performed in 1978 [27] and [28]. The Tecumseh data should only be considered as a rough guide as the data are old and probably underestimate the proportion infected, especially in young children [27]. Additionally, population density and mixing patterns are likely to have changed over the intervening years. In order to translate incident infections into clinical outcomes, the model was used to estimate the mean annual number of new influenza infections, prior to the introduction of any new Carnitine palmitoyltransferase II interventions. An estimate of the annual number of each clinical outcome was taken from a previous study of the burden of influenza [3]. Dividing the mean annual number of each outcome by the mean annual number of infections provided an age stratified estimate of the probability of a new infection leading to a general practice consultation, hospitalisation or death. The burden of influenza was measured using the age stratified mean annual number of general practice consultations, hospitalisations and deaths over 15 years, from 2009 to 2024 (Appendix A). Current practice in England and Wales involves vaccinating everyone over the age of 65 years and anyone between 6 months and 64 years of age in a defined risk group [29] with a trivalent inactivated vaccine (TIV). This policy was introduced in 2000.